Financial Outcomes of Health Insurers Under Government Intervention vs. Nonintervened EPS in Colombia: A 2023-2024 Comparative Analysis
Author(s)
JUAN C. FERNANDEZ MERCADO, MBA, MSc, PhD, MD1, Nelson Alvis-Guzman, MPH, PhD, MD2.
1UNIVERSIDAD DE CARTAGENA, Cartagena, Colombia, 2Universidad de Cartagena - ALZAK Foundation, Cartagena, Colombia.
1UNIVERSIDAD DE CARTAGENA, Cartagena, Colombia, 2Universidad de Cartagena - ALZAK Foundation, Cartagena, Colombia.
OBJECTIVES: To compare the financial performance of health insurers (EPS) in Colombia that were placed under government intervention with those operating normally, examining key financial outcomes between fiscal years 2023 and 2024. The study aims to evaluate whether administrative oversight correlates with improved cost containment, solvency, or sustainability.
METHODS: A retrospective financial analysis was performed using public financial statements, Superintendencia Nacional de Salud (Supersalud) bulletins, and insurer reports for the years 2023 and 2024. EPS were classified into two groups: intervened (e.g., Nueva EPS, Sanitas, Coosalud, Famisanar) and non-intervened (e.g., Sura, Salud Bolívar, Comfaoriente). Indicators included operating revenue, net profit/loss, medical loss ratio (MLR), administrative expenses, and user-based income-to-cost ratios. Statistical comparisons were made using adjusted averages weighted by affiliate volume.
RESULTS: By the end of 2024, intervened EPS accumulated greater financial deficits, with an average net loss of COP $156 billion, compared to a net surplus of COP $24 billion among non-intervened EPS. Medical loss ratios in intervened EPS averaged 96.2%, significantly higher than the 87.4% observed in non-intervened EPS. Furthermore, intervened insurers showed higher medication spending per capita (COP $28,500 vs. COP $17,200), largely driven by increased but uncoordinated risk cohort enrollment and poor cost controls. Administrative costs remained flat across both groups; however, liquidity indicators deteriorated faster in the intervened group.
CONCLUSIONS: EPS under government intervention demonstrated worse financial performance during 2023-2024 compared to their non-intervened counterparts. Oversight actions, though necessary, have not yielded improved financial stability in the short term. Without parallel implementation of risk-adjusted payment models, drug cost containment, and integrated care pathways, interventions risk becoming reactive rather than transformative. Future policy must prioritize fiscal sustainability along with user-centered reforms.
METHODS: A retrospective financial analysis was performed using public financial statements, Superintendencia Nacional de Salud (Supersalud) bulletins, and insurer reports for the years 2023 and 2024. EPS were classified into two groups: intervened (e.g., Nueva EPS, Sanitas, Coosalud, Famisanar) and non-intervened (e.g., Sura, Salud Bolívar, Comfaoriente). Indicators included operating revenue, net profit/loss, medical loss ratio (MLR), administrative expenses, and user-based income-to-cost ratios. Statistical comparisons were made using adjusted averages weighted by affiliate volume.
RESULTS: By the end of 2024, intervened EPS accumulated greater financial deficits, with an average net loss of COP $156 billion, compared to a net surplus of COP $24 billion among non-intervened EPS. Medical loss ratios in intervened EPS averaged 96.2%, significantly higher than the 87.4% observed in non-intervened EPS. Furthermore, intervened insurers showed higher medication spending per capita (COP $28,500 vs. COP $17,200), largely driven by increased but uncoordinated risk cohort enrollment and poor cost controls. Administrative costs remained flat across both groups; however, liquidity indicators deteriorated faster in the intervened group.
CONCLUSIONS: EPS under government intervention demonstrated worse financial performance during 2023-2024 compared to their non-intervened counterparts. Oversight actions, though necessary, have not yielded improved financial stability in the short term. Without parallel implementation of risk-adjusted payment models, drug cost containment, and integrated care pathways, interventions risk becoming reactive rather than transformative. Future policy must prioritize fiscal sustainability along with user-centered reforms.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE469
Topic
Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas